Some Facts About Q-Tips and Ears

In this week's episode of "Girls" (Season 2; Episode 9 "Girls Gets Dark"), Hannah grappling with OCD, inserted a Q-tip deep into her ear canal and "heard air hiss out the hole" due to perforating her eardrum.

Although this scene came out of a TV show, this scenario is not uncommon and results in many ENT office visits every month for not only eardrum perforations, but bleeding due to trauma to the ear canal skin.

Some facts about Q-tips as it relates to the ear...

It should never be used to clean earwax within the ear canal. In fact, on Unilever's website (the maker of Q-tips), the company explicitly states that Q-tips should only be used to "gently around the outer ear, without entering the ear canal." [link]

In fact, the word "ear" appears less than a dozen times on the entire Q-tip website.

Apparently, Q-tips are meant for many other uses beyond ears which play only a very small role in the world of Q-tips.

• Cleaning tiny spaces in ventilator grates
• Applying polishes to silverware
• Dust picture frames
• Clean keyboards and the computer screen
• Applying wood stain
• Clean tracks and grooves of medicine cabinets
• Clean small compartments of washing machines
etc, etc, etc

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Negative Ear Pressure Causing Inability to Pop a Clogged Ear

Have you ever closed the lid on an air-tight container containing a left-over hot meal and stuck it in the refrigerator? And than when you try to open the lid the next day once that hot meal cools down, it is REALLY hard to open the lid because of the accumulated negative pressure? In essence, the negative pressure has "locked" the lid down.

Well, something similar can also potentially happen inside the ear with eustachian tube dysfunction, especially with negative pressure (rather than positive pressure).

Eustachian tube dysfunction is a phenomenon whereby a person is unable to pop their ears to relieve symptoms of ear pressure, clogging, or fullness. It is much akin to the ear pressure a person experiences when flying, but at ground level. Traditionally, treatment of this condition involved medications like steroid nasal sprays and prednisone along with active valsalva (watch video below). Once medical treatment has failed, ear tube placement has been the step of last resort.

The question some patients have is WHY does it become so hard to get an ear to pop open with eustachian tube dysfunction...

It may be that the mucosal lining of the eustachian tube has swelled to the point that there is no opening present.

There may also be a physical obstruction blocking the eustachian tube due to large adenoids, nasal polyps, or some other nasal mass.

However, a lesser known phenomenon is due to the negative pressure itself creating a suction effect on the lining of the eustachian tube analagous to the stuck container lid mentioned in the first paragraph. The middle ear negative pressure itself may be literally "sucking" the lining of the eustachian tube closed. If the negative pressure is great enough, it may be very hard to get it open.

When this happens, the eustachian tube becomes "locked".

One can "mimic" this effect even in a healthy individual (not that anybody would want to try). When a swimmer dives deep into the water, some ear pain will start to develop due to the negative pressure building up in the middle ear. If the swimmer does not ear pop and continues to go deeper into the water, at around 3.9 feet, it may start to get very difficult to get the ear to pop open even with effort. At around 5 feet of water depth, it will become impossible to pop the ear open. Normally, swimmers and SCUBA divers continuously ear pop when diving at depth to prevent any ear discomfort.

As such, in situations where negative ear pressure is present and medications fail to resolve the ear clogging, a hole can be surgically made in the eardrum WITHOUT tube placement which will often resolve the symptoms fairly quickly. The hole "releases" the negative pressure to allow the eustachian tube to function normally. The analogy would be that once you release the negative pressure within an air-tight container, it becomes very easy to remove the lid thereafter.

The eardrum hole typically heals closed in a few weeks and the clogged ear sensation will often not come back. If it does, the myringotomy (surgically creating a eardrum hole) can be repeated and if necessary, a tube can be placed to prevent the body from healing the hole closed anytime soon.



Some things that have helped some people to pop their ears:

 

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Why Does Burping after Drinking Soda Burn the Nose?

I do not believe this question has actually been scientifically studied... but I can hazard a guess.

Sodas are those flavored fizzy drinks like Coca-Cola and Pepsi.

The "fizziness" is due to carbonation or carbon dioxide dissolved within the drink. When sodas are made, carbon dioxide is forced into the liquid under pressure so that there's more gas dissolved in the liquid than at regular air pressure. The bubbles you see and feel is caused by the carbon dioxide gas being released back into the air when exposed to back into regular air pressure (a closed can or bottle keeps the carbon dioxide under pressure within the liquid).

Such machines can even be purchased to make sodas at home (see below).

A soda becomes flat when all the carbon dioxide has been released back into the air.

In any case, why the burn?

Carbon dioxide (CO2) and water (H2O) together undergo a chemical reaction to form a very weak acid  called carbonic acid (H2CO3).

CO2 + H2O <--> H2CO3

So, after drinking some soda, the CO2 that is released reacts with the water inside your mouth, throat, and belly. The resulting carbonic acid, some of which is aerosolized, can than be burped up into the nose.

The nasal lining is quite sensitive, and when in contact with carbonic acid, can cause a burning sensation.

Now... does this actually happen?

Well, sounds like a potential neat research project that can potentially even be done by a high school student.

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Video on Ear Clogging and What Happens When They Pop Open (or Don't)

A new video has been created describing anatomically how a person pops the ear open when it feels clogged or under pressure. Also explained is what happens anatomically when the clogged ear is very difficult if not impossible to pop open; a condition called eustachian tube dysfunction.

Check the video out here!

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